RPP Authorization Form - Pennsylvania Insurance 2026

1. Click ‘Get Form’ to open the RPP Authorization Form in the editor.
2. Begin by entering your Policyholder Information. Fill in your name as it appears on the policy, along with the name of the person authorizing the withdrawal, ensuring it matches a name on the bank account.
3. Complete your address details including city, state, and zip code. Don’t forget to include your Insurance Account Number(s) as referenced on your invoice.
4. Next, provide your daytime phone number for any necessary follow-up communications.
5. In the Bank Information section, specify the name of your financial institution and select whether it's a personal or business account. Enter both the Bank Routing Number and Bank Account Number accurately.
6. Choose your preferred payment plan from the options provided for both personal and commercial lines policies. Make sure to review each option carefully before making a selection.
7. Finally, sign and date the form in the Authorized Signature section. Remember that this authorization cannot be processed without your signature.

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